Only the federalist public health system guarantees a rapid and effective containment of epidemics

On 22 September 2013 the Swiss people will vote on the complete revision of the Epidemics Act. With this act the well-functioning federalist public health system of Switzerland shall be replaced by a centralized system controlled by the Swiss Federal Office of Public Health (FOPH).

The following example will show how especially in case of dangerous infectiousdiseases only the federalist structure allows to act immediately and effectively to prevent a spread of the disease. Our general practitioners hold a key position in all that, which no central health center in Berne can take over.

Dealing with a notifiable disease

A sick person consults his general practitioner with whom he is familiar for years. The doctor knows the patient, his case history and his personal circumstances. In this case, the very sick-looking patient enters the family doctor’s surgery with highfever and diarrhea. The doctor examinesthe patient thoroughly and collects data about the current history. If necessary he initiates some laboratory tests. After having discovered a small spotted, discreet skin rash during the investigation in the navel area of the patient, the doctor expresses the suspicion of a typhus abdominalis, a notifiable severe infectious disease which requires a rapid further clarification, isolation, and treatment in hospital. On questions of the physician, the patient indicates that he had just returned froma long trekking tour in an Asian country.

The doctor informs the patient about the necessary measures and arranges for immediate hospitalization by an ambulance to a hospital suited for such diseases. Furthermore, the doctor informs the doctor on duty in the hospital and the doctor in the cantonal health authority about his suspicion. The doctor cares for a phone conversation of the patient with his wife from a mobile. The ambulance drivers are also informed about his suspicion. Finally, hygienic measures for epidemics protection are carried out in the surgery.

The procedure applied by the family doctor in the above example has been a long proven method which complies with the requirements of the current Epidemics Act. What would have been the help that the seriously sick, highly infectious patient got with the planned regime of the FOPH?

The family doctors provide true prevention. Since the doctor as the medical decision maker is no longer mentioned in the revised Epidemics Act (nEpG), there is suspicion, that a managing member of the FOPH, if necessary a member of the WHO, must travel to control the patient and his further whereabouts and his treatment. The autonomous activity of the family doctor is significantly cut, and he becomes a vicarious agent to apply measures imposed on him from above.

Just imagine: according to the nEpG the family doctor should report the case to the FOPH, which should first consult the WHO and ask them what to do; then WHO might conclude a “specific threat”, give an instruction to Switzerland, the FOPH will pass it on to the cantonal physician and he will finally tell the family doctor, what he has to do. In the meantime, many people have already been infected.

The planned Epidemics Act represents a paradigm shift

The tried and tested federalist structures of Swiss health care are undermined and responsibility shifts from the cantons to state level and the FOPH. Thus, the doctors are deprived of their competence; the relation of trust between the patient and his doctor is undermined. The relation of trust, however, is an essential basis for recovery.

The current and repeatedly amended Epidemics Act has proven to be good. So, the Swiss voters are well-advised to vote a clear No on the completely revised Epidemics Act in September.

Competition of the suppliers“ shall replace the relationship of trust between doctor and patient

The revised Epidemics Act (nEpG) misses to mention the doctor as the central decision maker in medicine. This is a deliberate act. Ilona Kickbusch, one of the main activists in drafting the nEpG, does not hesitate to talk about the abolition of the relationship of trust between doctor and patient in something she calls “new medicine”.

“Future-capability requires a fundamental change in the therapeutic relationship. The individual physician or therapist relationship is normalized in such a way that – like the rendering of other services in the health care sector – it basically follows the rules of our consumer world. This represents a transition from the ‘old medicine’ to the ‘new medicine’.

In the established self-image of academic medicine – (‘see one, treat one’ as per the Flexner Report, 1910) – there is a (paternalistic) single relationship based on confidence that does not demand further confidence building. However, the ‘new medicine’ is a cost-intensive mass market with high demand as well as rising specialization and division of labor. Within the perception of consumers, the comparison of services is important, and there should be competition between service providers. Particularly, for the protection of the patient, transparency is an indispensable pre-condition.

In this highly standardized field we are not talking about handicraft or art, but transparent performance. Therefore, a therapeutic relationship is obsolete if it is based on an individualistic conception and clinical purism.”